As I work in the ARU, I have given and assisted with many showers. Here is a guide for showers that can be adapted for acute care, ARU, SNF, home health, and other settings.
When in doubt, ask for clearance or an order for the MD before giving your patient a shower. I like to check in with the nurse beforehand as well in case there are any contraindications to showers in general, some dressings I need to be aware of, or anything else that may be pertinent. Be sure there are no procedures coming up in which a shower may not be a good idea.
The timing of showers is important, e.g., morning vs. afternoon. If a patient has an intense PT session after you on a Litegait, for example, it’s probably best to reschedule a shower another day.
If a patient is higher-level, they generally can get a shower done in about 30 minutes, including time to get dressed. This is assuming your patient does not have any other complications or special needs.
In the ARU, I usually schedule about an hour for showers, including time to get undressed and dressed. If a patient has a complicated transfer that requires more set-up or moves slower, I may schedule a 1 and half hour shower.
The most common preparation you will need to do if nursing has not already is to cover up areas that should or may not get wet. While you are not necessarily submerging body parts, it’s a good idea to not get them wet in general to avoid infection or slower wound healing.
Depending on your facility, you may be able to assist with putting on water-occlusive dressings. Check with the MD, e.g. neurosurgeon or orthopedic surgeon if certain things can get wet, e.g., staples. When in doubt, cover it up – I like to use clear plastic removable adhesives and plastic bags.
A common area that requires covering is the back after back surgeries.
Check if the hair can get wet, e.g., craniectomies, staples, if helmets can be removed if seated, etc.
The upper and lower extremities can be covered up with trash bags and then taped around circumferentially (do not cut off circulation) with waterproof tape. Have tape handy (or put in your pocket). You can often find garbage bags near the trash can or under if your EVS likes to do this.
When working with patients with thin or fragile skin, be careful of the type of tape you use and especially careful when peeling off the tape (tip: go slow).
Seated vs Standing
When in doubt, have the patient sit first, then gauge their safety awareness, strength, endurance, etc. It’s a good idea to have at least a shower stool or chair in the shower in case of fatigue, nausea, poor balance, etc. Try and put chairs near the grab bars if present.
Pre-adjust the height of stools, chairs, or benches or you will be wasting a lot of time or over-tiring your patient.
As anti-slip mats are not good for infections in the hospital, you can use a large towel on the ground to prevent slipping.
- A/E if needed, e.g., sock aid, dressing stick, reacher
- Waterproof dressings
- Gloves and PPE
- New change of clothes for the patient (hospital socks may be better than patient’s socks due to fall risks).
- Adult briefs
- Oxygen, tubing
- Lots of towels, e.g., 5+ (to dry off the ground afterwards)
- Hair ties
- Female hygiene pads
- Toothbrush and toothpaste
- Shaving supplies (no blades if on bloodthinners)
- What the patient prefers to use (if they have their own shampoo, soap, etc. for their routine).
- Keep an eye on the time (including time to get dressed and go back to the patient’s room).
- Plan the transfer on and off the shower surface.
- Bring a gaitbelt.
- If the water takes a long time to warm up, keep your patient dressed.
- Remove hearing aids before running the water!!!
- Be careful not to flood the shower/floor.
- Don’t give your patient the showerhead unless you really trust them (or set the spray nozzle to low spray and not massage spray).
- Tell your nurse where you patient will be and what you plan to do.
- Don’t overfatigue your patient if they have PT immediately after, e.g., a PT evaluation.
- Plan to dress your patient afterwards (either in the shower area or in their room, in which case you should bring a clean hospital gown to drape over them).
- Follow infection protocols, e.g., C-dif. Post a sign for “do not use” and ask CVS to disinfect before another patient uses the shower.
- Bring an extra towel to dry or tie hair in a turbon.
- Plan to get wet. Have an extra pair of scrubs or clothes. Definitely have extra socks and extra shoes would be best.
- Educate on precautions when orthotics are doffed, e.g., TLSO.
- Move clothes and equipment out of the way so they do not get wet.
- If a patient has poor sitting balance, they may be unsafe for showers, even on rolling shower commodes.
- If using a Sara Stedy, plan to have enough space for the platforms to swing-out.
- When patients start having pain, plan to cut the shower short as this can rapidly go up when sitting on a firm shower surface.
- Have a bucket nearby as some patients may be incontinent and may have an episode or need to go urgently (and without warning), especially when seated on commodes or shower chairs with cut-outs that are similar to toilet seats.
- Cover up IV dressings, PICC lines, and ports (ask nursing if unsure how).
- Ask how to best manage ostomies.
- Have a place to store eyeglasses, hearing aids, necklaces, watches, etc. It may be best to leave these in the patient’s rooms.
- Most patients like to run the water hot, but avoid this if it is contraindicated, e.g., MS, cardiac, poor cognitive function.
- Mimic the natural home environment if possible.
- Pre-order DME, e.g., shower chair or bench if the patient will need one upon D/C.
- Pay attention to the body parts for assistance scoring. I made a shower calculator to help with this for the CARE Item Set.
As a male OT, do you find it difficult to give showers to females?
While in general, most females would rather have a female OT work with them, most of the time this is not an issue for me. First, have your team such as the PTs ‘talk you up’, e.g., “he is very professional” and “most females do not mind and actually prefer working with him”. Have the nurse do the same if they know you. Tell your patient ahead of time so they are aware and can get used to the idea. It helps that your patient knows you already. So try not to give a shower the first time you meet a female patient. If I do not know them, I like to spend a few minutes if I have time to introduce myself in the morning so they can put a name to a face and be more comfortable with the idea of a male assisting them in a shower such as later in the afternoon. Most females are generally okay because they have not had a shower in so long that it does not matter to them as much.
Sometimes I like to say, “Hi, Mrs. Jones, I will be your OT today and assisting you with a shower. Let me know how I can make it more comfortable for you today. I am scheduled to assist you and there are no females available, but if this is not okay with you, let me know.” It is kind of like using PLISSIT and addressing the issue directly for patients who may be more modest.
Use your therapeutic use of self (I like to be funny), and allow them privacy when possible. If a patient is safe, I generally step out or wait behind the curtain and provide stand-by assist. One thing you can do is provide females with large towels to cover up their breasts, for example.
While I have not counted the number of times I have been turned down for a shower with a female, it is very low, probably 5% of the time? These are generally females who may have a traumatic event, e.g., sexual abuse, or younger women, in which I try to schedule showers with my female OT colleagues and trade them for male patients, for example. I think what really helps is when the PTs (who are females themselves) talk me up and tell them that I am professional when it comes to toileting and showers. It probably also helps that I wear my wedding ring at work.
I think it works both ways and is nice to have a male OT on the team. Female OTs can trade for male patients who may inappropriate and some younger male patients may feel uncomfortable working with a female OT for toileting, showers, etc.
Safety is your number 1 priority as we all know that showers are the #1 places patients fall. I actually have not had a patient fall in the shower yet, but I am very cautious and careful. Some colleagues have had patients fall mostly during the transfers. Patients are generally fine when seated in a good 90-90-90. If their sitting balance is very poor, they probably are not safe for a shower yet. Don’t rush and good luck!
P.S. Rolling shower commodes are horrible for comfort and are not well received by my patients with back pain.